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The Medical Minute: Screen for developmental hip dysplasia in infants

March 3, 2009

The Medical Minute: Screen for developmental hip dysplasia in infants

By William L. Hennrikus

Developmental Dysplasia (DDH) describes the abnormal dislocated position of the femoral head (the ball part of the hip joint) out of the acetabulum (otherwise known as the cup) in the hip of infants. This disorder can lead to hip arthritis later in life if not treated in infancy. Early detection of DDH by regularly scheduled physical examinations can lead to simple, effective treatment with a Pavlik harness.

The incidence of DDH is about one to two per 1,000 newborns and is highest in females born in the breech position — feet first. Primary care physicians examine the hips of all newborns and repeat the hip examination at well baby visits until the child is walking — about age 1. Specifically, the infant hip exam includes the Barlow and Ortolani maneuvers. The Barlow maneuver pushes the located hip to a dislocated position and the Ortolani maneuver relocates the dislocated hip.

Any infant with an abnormal hip exam is referred to a pediatric orthopaedic surgeon for confirmation of the diagnosis and treatment with a Pavlik harness, which is used to treat infants up to 6 months of age. This simple brace successfully stabilizes the hip without surgery in more than 90 percent of cases. The side effects of the harness are few, with a less than 1 percent risk of avascular necrosis (AVN) of the femoral head, in which the ball joint loses part of its blood supply.

Ultrasound imaging is used in some cases to confirm diagnosis and monitor treatment while in the Pavlik harness. Universal ultrasound screening is not recommended. However, due to the high risk of DDH in females born breech, ultrasound imaging is recommended at 6 weeks old or a radiograph at 4 months old for this subset of infants.

Despite the best screening programs, including programs using ultrasound, about one in 5,000 infants still present with DDH later in infancy or after walking age. These rare cases are examples of late onset DDH rather than a missed hip dislocation.

In conclusion, early detection of DDH can lead to simple, effective treatment of a condition that, if left untreated, can result in pain, arthritis and disability. Periodic physical exam of the hips during the first year of life is the primary hip screening tool. The Pavlik harness is the primary treatment method.

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William L. Hennrikus is a professor in pediatric orthopaedics and sports medicine, Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center.